Joaquín “El Chapo” Guzmán, the world’s most famous drug lord, is losing his mind. He has trouble remembering recent events, he has bouts of depression and anxiety, and he can barely sleep. He might be losing his body as well. Life in prison has given him constant respiratory problems, and he may be facing a serious heart condition. He fears he will not make it to December.

Or so claims Emma Coronel, his common-law wife, and his team of lawyers. Mexican authorities disagree. According to Eduardo Guerrero, head of the federal penitentiary system, El Chapo has been battling a nasty, but far from life-threatening, cold. He is receiving treatment for a sore throat, along with some over-the-counter analgesics and a sleeping pill that doubles up as an anxiety reliever.

As far as can be ascertained from the outside, the official version is probably true. There is simply no evidence that the imprisoned drug trafficker is seriously ill. While he was on the run, there were claims that he had both diabetes and hypertension, but this turned out to be false. In one of Guzman’s hideouts, Mexican marines did indeed find various medications, but they were intended for the treatment of asthma and (wait for it) hemorrhoids.

So if he is not dying or going insane (by sociopathic killer standards, anyway), what’s behind the dire claims? It’s a ploy to gain some time.

Famously, El Chapo has escaped twice from Mexican high-security prisons: Once in 2001, in a cart of dirty laundry, and most recently in July 2015, using a mile-long tunnel that led directly to his cell. He was recaptured again in Sinaloa in 2016. For rather obvious reasons, these escapes have been deeply embarrassing for the Mexican government. To prevent further humiliation, authorities belatedly agreed to extradite Guzmán to the United States. That willingness was formalized in May, when Mexico’s foreign ministry announced that it had accepted a formal extradition request from the U.S. government.

The drug lord’s legal team has been battling that decision for the past six months, with little luck so far. On Oct. 21, a federal judge rejected two different attempts by Guzmán to obtain a stay on his extradition. His lawyers have announced that they will appeal that ruling and the case may end up in Mexico’s Supreme Court.

Does he stand a chance in higher courts? It’s hard to say, but one thing is certain: If he loses those appeals, there would no longer be any legal hurdles to prevent his departure to the United States. It could mean the end of his long criminal career and the beginning of a life spent in a maximum-security American facility, with little or no contact with other human beings.

On top of that, El Chapo’s legal troubles come at an awkward time for his criminal organization. The once all-mighty Sinaloa Cartel is looking vulnerable these days. In June, as many as 150 henchmen, affiliated with the rival Beltrán-Leyva organization, descended on Badiraguato, Guzmán’s hometown, and attacked his mother’s house. Then, in August, two of El Chapo’s sons were kidnapped in the resort town of Puerto Vallarta and mysteriously released a few days later.

That abduction was allegedly the work of the Jalisco New Generation Cartel, an upstart organization that is vying to become Mexico’s most powerful crime syndicate. Once seen as junior partners to the Sinaloans, they are now challenging their former masters all over the map.